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Flashcards in Pediatrics Deck (145):
1

What two things should be provided to the newborn at birth and why?

Erythromycin ointment (ward off bacterial infection)
Vitamin K (prevent hemorrhagic disease)

2

Before discharging the newborn and mother what additional tests should you complete?

Hearing screen
Give mom HBV vaccine if HBsAg negative (admin HBV vaccine and HBV Ig if positive)
Neonatal screening tests

3

APGAR at 1 minute tells about _______
at 5 minutes tells about ______

1 minute: labor and delivery
5 minute: response to therapy

4

What should you rule out when seeing Mongolian spots?

Child abuse

5

Newborn presents on second day of life with firm papules on an erythematous base. What are these and what is mgmt?

Erythema toxicum
Self-limited

6

What constellation of symptoms may be seen in Sturge-Weber syndrome?

Port wine stain
AVM resulting in seizures
Mental retardation
Glaucoma

7

Mgmt of Sturge-Weber Syndrome?

Pulsed laser therapy, AEDs, and evaluate for glaucoma

8

Treatment for large hemangiomas which are at risk for causing organ dysfunction to shifting cardiac output in a newborn?

Steroids or pulsed laser

9

Preauricular tags in newborn assd with ...

Hearing loss
GU anomalies

10

Iris defect in newborn should raise suspicion for what syndrome?

CHARGE

Coloboma
Heart defects
Atresia of nasal choanae
Retardatioon of growth
GU anomalies
Ear abnormalities

11

Absence of iris is red flag for ...?

Wilms tumor

12

What type of surveillance should Wilm's tumor patients undergo?

Abdominal US every 3 months until the age of 8

13

Newborn presenting with neck mass lateral to the midline is ...

Branchial cleft cyst

14

Distinguish omphalocele vs gastroschisis

Omphalocele: GI organs outside of body but covered by peritoneum
Gastroschisis: GI organs outside of body with no covering

15

Umbilical hernia in newborn raises concern for ...

Hypothyroidism

16

In newborns with undescended testes what is mgmt?

No treatment until 1 year of age
At that time either hormone injections or orchiopexy

17

Should you circumcise hypospadias?

No

18

What abnormalities are seen in infants of diabetic mothers?

Hypoglycemia
Hypocalcemia
Hypomagnesia
Hyperbilirubinemia
Polycythemia

Cardiac anomalies
Small left colon syndrome

19

What causes transient tachypnea of the newborn and how long does it generally last?

Retained lung fluid in newborns delivered by C-section or with a rapid second stage of labor

20

What medicine do you provide to prevent respiratory distress in a potentially premature newborn?

Antenatal betamethasone when

21

What are ventilator settings you would use in a newborn with meconium aspiration?

High frequency ventilation
PEEP

22

What is mgmt of diaphragmatic hernia?

Immediate intubation and surgical correction

23

How do you treat meconium plugs and meconium ileus?

Get abd xray and give gastrografin enema

24

What is part of the VACTERL syndrome?

Vertebral defects
Anal atresia
Cardiac anomalies
TEF with ...
Esophageal atresia
Radial and Renal anomalies
Limb Syndrome

25

What is treatment of newborn born with duodenal atresia (double bubble on xray)?

NG decompression and surgical correction

26

Greatest risk factor of NEC ...

Premature delivery

27

Mgmt of NEC

Stop feeding
Decompress gut
Broad spectrum antibiotics
Evaluate for surgical resection

28

Your patient fails to pass stool early in course and upon digital exam a large volume passes. Dx?
What is the next part of the work-up?
What is a confirmatory test?

Hirschsprung disease
Barium enema
Rectal biopsy (absence of ganglionic cells)

29

Mgmt of kernicterus

Immediate transfusion exchange

30

If a newborn presents with jaundice and elevated conjugated bilirubin then what should you consider and the tests you should order?

Cholestasis

Get LFTs and consider US and liver biopsy

31

Early onset sepsis in a newborn is most often from ....

PNA (GBS, E. coli, H. influenzae, L. monocytogenes)

32

Late onset sepsis in newborn is most often from ....

Meningitis or bacteremia (S. aureus, E. coli, Klebsiella, Pseudomonas?

33

What is empiric treatment of sepsis in newborn?

Ampicillin and gentamicin
If meningitis possible consider adding cefotaxime

34

Buzzwords

Hydrocephalus with generalized intracranial calcifications and chorioretinitis

Toxo in newborn

35

What is the best initial test for Herpes dx in newborn? Most accurate?

Initial: Tzanck
Accurate: HSV PCR

36

Best initial test for syphilis in newborn?
Most accurate?

Initial: VDRL
Accurate: IgM-FTA-ABS

37

What tests should be ordered in working up seizures in the newborn?

EEG
CBC, glucose, calcium, magnesium
Amino acid and urine organic acids for inborn errors of metabolism
IgM levels
Blood and urine cultures
LP
Ultrasound head - look for IVH

38

Tx of seizure in newborn?

Lorazepam or diazepam (rectally)

Ethosuximide if absence

39

Of the following: heroin, methadone, cocaine, amphetamines, and alochol which presents with withdrawal in newborns at 48 hrs and which at 96 hrs to up to 2 weeks?

48 hrs: cocaine, heroin, alcohol amphetamines

96 hrs to 2 weeks: methadone

40

Is it acceptable to give narcan to a newborn?

No it may trigger withdrawal. It is acceptable to give small doses of opiates and phenobarbital

41

Effect on newborn

Phenobarbital

Vitamin K deficiency

42

Effect on newborn

Sulfonamides

Displaces bilirubin from albumin and increases risk of kernicterus

43

Effect on newborn

NSAIDS

Premature closure of ductus arteriosus

44

Effect on newborn

ACEi

Craniofacial abnormalities

45

Effect on newborn

Isoretinoin

Facial and ear anomalies, congenital heart disease

46

Effect on newborn

Phenytoin

Hypoplastic nails, typical facies, IUGR

47

Effect on newborn

Diethylstilbestrol (DES)

Vaginal adenocarcinoma

48

Effect on newborn

Lithium

Ebstein's anomaly (atrialization of RV due to ineffective tricuspid valve leaflets)

49

Effect on newborn

Warfarin

Facial dysmorphism and chondrodysplasia

50

Effect on newborn

Valproate/Carbamazepine

Mental retardation, neural tube defects

51

Buzzwords

Trisomy with rocker bottom feet and hammer toe; micrognathia; microcephaly

Trisomy 18 Edwards Syndrome

52

Buzzwords

Trisomy with holoproencephaly, cleft lip/palate

Trisomy 13 Patau Syndrome

53

What kind of regular surveillance should you complete in patients with Beckwith-Weideman Syndrome and to look for what?

Ultrasound and serum AFP every 6 weeks to look for Wilm's tumor and hepatoblastoma

54

What are features of Robin (Pierre Robin) sequence and what complication should you watch for over the first 4 weeks of life?

Mandibular hypoplasia and cleft palate
(Assd with Edwards syndrome and fetal alcohol syndrome)

*Watch for airway obstruction in first 4 weeks of life

55

Height percentile at which age correlates with final adult height percentile?

2 years old

56

Advantages of breastfeeding

Passive immunity via T-cell transfer which reduces risk of allergy and GI/respiratory infection

Emotional bonding with mother

57

Contraindications to breast feeding

HIV
Galactosemia
Active drug use (e.g. cocaine, opiates, heroin)
Systemic illness (e.g. TB)
HSV (if lesions on breast)
Maternal cancer receiving treatment

58

Until what age is enuresis normal?

5 years old

59

Until which age is encopresis normal?

4 years old

60

For retentive encopresis what are appropriate therapies to use in mgmt?

Stool softeners
Disimpaction
Behavioral modifications

61

Patients with a known egg allergy should receive which form of influenza vaccine?

Trivalent inactivates influenza vaccine

62

Newborn is exposed to Measles in mother. Is 5 months old. What is tx?

Just give Ig

(If 6-12 months when exposed then give Ig and vaccine)

63

Neck Xray showing steeple sign is positive for what disease?

Croup (caused by parainflulenza)

64

Mgmt of croup

Humidified oxygen
Nebulized epinephrine and corticosteroids

65

Patient presents with drooling and muffled voice. Neck Xray shows 'thumbprint' sign. Dx and mgmt?

Epiglottitis (often Hib)

Emergency - get anesthesia and ENT
Intubate if needed
Ceftriaxone and steroids
Rifampin ppx to household contacts

66

3 yo patient presents after having a URI last week with fever, cough, and respiratory distress. He is not drooling or has a changed voice. CXR shows subglottic narrowing. Dx, cause, and mgmt?

Bacterial tracheitis
S. aureus
Antistaph Antibx

67

What mediates the development of angioedema?

Bradykinin

68

Where are the most common sites for foreign body aspiration in kids older and younger than 1 year of age?

>1 yo: larynx

69

Causes of bronchiolitis

RSV
Parainfluenza
Adenovirus

70

Most specific test for bronchiolitis dx

Viral antigen testing (IFA or ELISA)

71

What is a routine way to prevent bronchiolitis development in young children?

What is used to prevent it in high risk patients?

Routine: Breastfeeding which provides IgA which helps prevent respiratory illnesses (disease occurring across mucosal linings)

High Risk: Palivizumab (against RSV F protein)

72

What is the most common pathogen causing PNA in children

Viral - RSV

73

What are the most common pathogens causing PNA in children > 5 yo?

S. pneumoniae
M. pneumoniae
C. pneumoniae

74

A 2 month old infant presents with staccato cough and peripheral eosinophilia noticed on CBC. Had conjunctivitis at birth. What is Dx?

Chlamydia trachomatis pneumonia

75

Are sputum cultures helpful in the dx of PNA in children

No

76

For mild cases of PNA handled in outpatient setting what is an appropriate treatment?

Amoxicillin
(Alternatives are cefuroxime and amoxicillin/clavulanic acid)

77

In hospitalized patients with PNA what is appropriate tx?

IV cefuroxime

78

In Chlamydia or Mycoplasma pneumoniae what is appropriate tx?

Erythromycin

79

Absent vas deferens and allergic bronchopulmonary aspergillosis are assd with what genetic condition?

Cystic fibrosis

80

What is the first symptom cystic fibrosis often presents with?

Meconium ileus

81

What is the first approved therapy for CF which restores the function of the mutant CF protein given to patients > 6 yo with G551D mutations?

Ivacaftor (VX - 770)

82

What are common organisms causing infection in CF?

S. aureus
Pseudomonas
H. influenzae

83

For resistant pathogens in CF patients what antibiotics do you use?

Inhaled tobramycin

84

In CF patients infected with S. aureus or Pseudomonas what is appropriate treatment?

Piperacillin and tobramycin/ceftazidime

85

When is a surgical repair for VSD indicated?

Failure to thrive
R: L shunt > 2:1
Pulm HTN

86

How are primary and sinus type ASDs managed?

They are closed surgically

87

In newborn with pulmonary stenosis what should they be given at birth and how should they managed in the longterm?

Give prostaglandin E1 infusion at birth (keeps PDA open) and attempt balloon valvuloplasty later

88

What drug is used to close a PDA?

Indomethacin

89

What drug is used to maintain the ductus arteriosus?

Prostaglandin E1 infusion

90

When should you attempt surgical repair of tetralogy of Fallot?

4-12 months

*Before that give oxygen, beta blocker, PGE1 infusion

91

Which cyanotic congenital heart disease lesion presents immediately after birth? How is it managed?

Transposition of great vessels
Prostaglandin E1 to keep PDA open and attempt surgical repair ASAP

92

Gram negative spiral that is motile with flagella

Campylobacter (a cause of bloody diarrhea)

93

Antibx tx of:

Shigella

TMP/SMX

94

Antibx tx of:

Salmonella

Only treat those

95

What is treatment of HUS from suspected E. coli O157:H7?

Do NOT give antibiotics

Supportive, HTN control, aggressive nutrition, early dialysis

96

What is the best initial test for fat malabsorption?
Best confirmatory test?

Initial: Sudan black stain
Confirmatory: 72 hour stool for fecal fat

97

Best initial test for protein malabsorption

Spot stool alpha-1 antitrypsin level

98

What is the best initial test in pediatric GERD dx?

Esophageal pH monitoring

99

What are first line GERD meds in children?

H2 receptor blockers (e.g. ranitidine) are first line bc of an improved safety profile

100

Hypochloremic metabolic alkalosis is pathognomonic of what?

Pyloric stenosis

101

How can pyloric stenosis and duodenal atresia be distinguished on exam?

Pyloric stenosis presents with nonbilious vomitus
Duodenal aresia has bilious vomitus

102

What is both diagnostic and therapeutic in intussuception?

Air enema

103

Tx pediatric cystitis

Amoxicillin or SMP/TMX

104

Tx pediatric pyelonephritis

IV ceftriaxone or ampicillin/gentamicin

105

In patients with vesicoureteral reflux what is provided as ppx against renal scarring?

They get multiple UTIs so give TMP-SMX

106

What are the best initial tests in obstructive uropathy?
What is the most common cause in boys?
What is the most common cause in newborns?

Voiding cystourethrogram and renal scan
Boys: Posterior urethral valves
Newborns: Hydronephrosis and polycystic kidney disease

107

Acute post-strep glomerulonephritis occurs after what infections?

Post strep pharyngitis or impetigo

108

What unique test results are seen in APGN?
What is the most specific test?

Low C3 complement, anti-streptococcal antigens
Specific test: Anti-DNase antigen

109

Tx of APGN

Penicillin
Supportive (diuresis, sodium restriction, electrolyte mgmt)

110

20 yo patients presents with hematuria after URI and has a normal complement level. Dx?

Berger's nephropathy (IgA nephropathy)

111

What is tx of infantile (recessive type) polycystic kidney disease?

Dialysis and transplant

112

What benign cause of proteinuria should be ruled out before any additional work-up be completed?

For transient or orthostatic proteinuria

113

What are two complications of nephrotic syndrome in children?

Increased risk of SBP (immunize against pneumococcus and varicella)
Increased VTE risk (prothrombotic)

114

How does 21-hydroxylase deficiency present on a BMP and vitals?

Hyperkalemia, hyponatremia, hypoglycemia
Hypotension
*Females will also have ambiguous genitalia

115

Tx of 21-hydroxylase deficiency

Hydrocortisone and fludrocortisone
Corrective surgery for females

116

How does Kawasaki disease present?

Fever
Desquammating rash on hands
Lymphadenitis (cervical)
Conjunctivitis
Strawberry tongue/cracked lips
Erythema and swelling of hands/feet
Nonvesicular rash

117

Tx of Kawasaki disease

Aspirin and IVIG
*May consider adding warfarin, especially if platelet count high

118

What are major complications of Kawasaki disease?

Coronary artery aneurysms

119

Intussusception, arthritis, and glomerulonephritis/nephrosis all may develop in what IgA and C3 mediated disease?

Henoch-Schonlein Purpura

120

Increased IgA and IgM
Antiphospholipid or anticardiolipin antibodies
The above may be seen in what disease?

HSP

121

What is tx of HSP?

If anticardiolipin or antiphospholipid are present then give ASA.
If there are intestinal or renal complications then give corticosteroids

122

When is there a physiological anemia in newborns and why does it occur?

At 12 weeks it nadirs at 9-11 mg/dL. This is due to progressive drop in EPO production until tissue oxygen needs are greater than they were at delivery

123

Infants only receiving cow's milk are at increased risk of which anemia?

IDA

124

What types of bacteria are patients with sickle cell disease susceptible to and why?

Encapsulated abcteria bc they undergo autosplenectomy by age 5; Strep pneumo, Hib, N. meningitidis

125

What are the most common causes of death in sickle cell?

Sepsis and acute chest syndrome

126

Your patient with sickle cell anemia presents with SOB and chest pain. Do you do transfuse blood or do an exchange transfusion?

Transfuse

127

In what situations is an exchange transfusion indicated for sickle cell anemia?

Life-threatening complications (stroke, acute chest, splenic crisis)
Before high-risk surgery

128

What drug reduces number of recurrent painful crises and needs for exchange of transfusion?

Hydroxyurea

129

What is the only definitive treatment of sickle cell disease?

BM transplant (but carries a 10% mortality)

130

What ppx measures are taken in sickle cell disease pts?

Penicillin ppx from 6 mos until 5 years of age
Regular immunizations but with early pneumococcus and meningitis vaccines

131

When and how does Beta thalassemia major present?

At 2 months with severe anemia (Hb

132

What are findings on hemoglobin electrophoresis in a patient with Beta thalassemia major?

HbF is increased
HbA2 may be increased
Absent or reduced HbA

133

Low reticulocytes
Microcytosis
Hemolysis consistent labs
Elevated ferritin and transferrin saturation

Dx?

Beta thalassemia major

134

How is Beta thalassmeia managed?

Transfusion to maintain Hb > 9
Iron chelation (deferoxamine and vitamin C)
Splenectomy
Routine (folate, vaccine, growth hormone)
BM transplant is curative

135

How are mixing studies helpful in diagnosing hemorrhagic disorders?

Involves mixing normal plasma to the patient's plasma and repeating PT/PTT/INR

136

If lab prolongation is not corrected in a mixing study what does that mean?

An inhibitor is present (e.g. heparin in hospitalized patients)

137

If a mixing study shows more prolonged bleeding with clinical bleeding what does that mean? What if there is no clinical bleeding?

w/ bleeding: an antibody against a clotting factor is present

w/o bleeding: possibly lupus anticoagulant

138

How is minor bleeding in hemophilia A treated?
Major bleeding?

Minor: desmopression, transexamic acid or aminocaproic acid
Major: Factor VIII supplemetation

139

What are treatment options in ITP?

1st: prednisone
2nd: IVIG

Chronic ITP may benefit from rituximab or splenectomy

140

In what situations is a child with a febrile seizure at higher risk for epilepsy?

Atypical seizure (>15mins)
Previous neurologic condition
Abnl development
FHx of epilepsy

141

15 yo has a seizure described as jerky movements in the morning. Dx? Mgmt?

Juvenille myoclonic epilepsy
Valproic acid

142

What is hypsarrhythmia? What epileptic syndrome is it seen in? Mgmt?

High voltage slow waves irregularly interespersed with spike and sharp waves.
West syndrome (infantile spasms during 1st year of life)
Tx: ACTH, prednisone, vigabatrin, pyridoxine

143

What is first line medication for generalized seizure in child?

Valproic acid

144

What are first line meds for partial seizure in pediatrics?

Valproic acid or carbamazepine

145

What is the most common long term complication of meningitis?

Hearing loss